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Intensity-Modulated Radiation Therapy for Anal CancerHistorically, the treatment of squamous cell carcinoma of the anal canal has been an abdominoperineal resection (APR), resulting in loss of the anus and rectum with need for a permanent colostomy.
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Commentary (Lenzi/Yalcin): Management of Patients With Cancer of Unknown Primary SiteThe article by Drs. Hainsworth and Greco is a timely review of the management of patients presenting with metastatic cancer in the absence of a documented site of origin (cancer of unknown primary site). These patients constitute a significant proportion (approximately 5%) of all patients with cancer.
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Brachytherapy for Carcinoma of the LungAn estimated 157,000 patients died of lung cancer in the United States in the year 2000.[1] Although surgery can be curative, only about 20% of patients are amenable to complete surgical resection. Most of the other patients are treated with radiation
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Curbing Potential Radiation-Induced Cancer Risks in Oncologic Imaging: Perspectives From the ‘Image Gently’ and ‘Image Wisely’ CampaignsThe purpose of this review is to provide the oncology community with knowledge about the doses used in medical imaging, radiation-induced cancer risks from imaging, and considerations to keep in mind when balancing imaging benefits and risks in pediatric and adult oncologic settings.
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Counseling Women at High Risk of Ovarian or Endometrial CancerPatient education and counseling are essential in women at increased risk for ovarian and endometrial cancer. Women must be educated regarding the signs, symptoms, and risks associated with these cancers.
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Radium-223: Optimizing Treatment and Research of Osteoblastic Bone MetastasisElucidation of the underlying mechanisms of action for Ra-223 will soon expand its clinical utility with respect to improved patient selection and integrated bone-targeted therapies.
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Commentary (Neuwelt/Dahlborg): Current Management of Primary Central Nervous System LymphomaDr. DeAngelis has written a succinct and accurate assessment of management of primary central nervous system lymphoma. Non-AIDS-related primary central nervous system lymphoma is a rare, highly malignant primary brain tumor. However, its incidence is increasing, as are AIDS-related tumors of this type. Patients with primary central nervous system lymphoma usually have widespread infiltration throughout the brain, rendering aggressive resection of no benefit. There is a significant incidence of leptomeningeal and ocular involvement (the latter a "sanctuary site," thus posing a particular therapeutic dilemma).
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ACR Appropriateness Criteria® Recurrent Hodgkin LymphomaBy combining the most recent medical literature and expert opinion, this revised guideline can aid clinicians in the complex decision-making associated with the management of recurrent Hodgkin lymphoma.
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Assessment of Colorectal Cancer Screening Awareness, Preferences in JordanIn this video from the 2015 ONS meeting, Dr. Omran discusses the high-risk of colorectal cancer among the Jordanian population and the need to promote more screening awareness.
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Molecular Classification of Diffuse GliomasSignificant progress has been made in defining molecular signatures in diffuse gliomas. The clinically significant genetic alterations identified to date probably represent the tip of the iceberg, since new, potentially significant biomarkers are continuously described.
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Neoadjuvant Therapy for Hepatocellular Carcinoma: Is There An Optimal Approach?Hepatocellular carcinoma (HCC) is an aggressive tumor that often occurs in the setting of chronic liver disease and cirrhosis. The incidence of hepatocellular carcinoma is increasing in the United States and worldwide. Orthotopic liver transplantation (OLT) is a viable and potentially curative option for selected patients with HCC. Locoregional therapy has been used to control HCC before transplantation because of the limited number of donor organs, to prevent tumor progression, and to decrease the incidence of dropouts from the transplant waiting list. Traditionally, multiple investigational locoregional modalities such as tumor resection, radiofrequency ablation, transarterial chemoembolization, and systemic chemotherapy have been used as "bridging" therapies. While the investigation of novel neoadjuvant treatments is justified in an effort to prevent tumor progression, the absence of randomized controlled trials leaves uncertainty about the utility of these maneuvers in improving outcome. This review summarizes the current data on the different modalities used worldwide in the neoadjuvant treatment of hepatocellular carcinoma, the rationale for these approaches, efficacy, potential complications, and future prospects.
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Deferasirox for the Treatment of Chronic Iron Overload in Transfusional HemosiderosisThis report describes the Food and Drug Administration's review of data and analyses leading to the approval of the oral iron chelator, deferasirox for the treatment of chronic iron overload due to transfusional hemosiderosis.
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Clinical Pearls and Key Takeaways on Kidney Cancer TreatmentSumanta Kumar Pal, MD, FASCO, provides advice for community oncologists, and the Oncology Brothers review key points from the discussion.
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Contemporary Management of Small Renal MassesDespite improved understanding of the molecular features of renal tumors, increasing expertise in surgical management of localized renal cancers, and multiple effective systemic therapies for metastatic cancer, mortality from renal cell carcinoma remains largely unchanged.
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UFT in Bladder CancerUFT, a compound containing uracil and tegafur (a prodrug of 5-fluorouracil) in a 4:1 molar ratio, has been used in Japan for the treatment of and as adjuvant chemotherapy for bladder cancer. In phase II studies, 300 to 600
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Improving the Therapeutic Benefits of IpilimumabCurrently there are only three FDA-approved drugs available for the treatment of metastatic melanoma: dacarbazine, interleukin-2, and the lesser-used hydroxyurea. None of these drugs has been shown to improve overall survival (OS). The review by Thumar and Kluger provides a well-balanced overview of ipilimumab, the first agent to demonstrate a survival benefit in patients with metastatic melanoma.[1] The response to ipilimumab is most notable for its durability, a feature rarely observed in patients with high tumor burden or in response to other systemic therapies. However, a minority of patients (10% to 15%) treated with ipilimumab meet standard criteria for radiographic response. In this commentary, we focus on the question of how we can build on the success of ipilimumab. We briefly review one area of active investigation: the combination of ipilimumab with targeted inhibitors of BRAF.
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Is Personalized Medicine Here?This review describes the achievements in therapeutic and molecular diagnostics, details evolving molecular platforms, and highlights the challenges for the translation of these developments to daily clinical practice.
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Multiple Myeloma Management: Addressing Disparities in CareBefore closing out their review on the management of multiple myeloma, panelists consider disparities in care and share how these barriers are being addressed.
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Novel Androgen Receptor Signaling Inhibitors for Nonmetastatic Castration-Resistant Prostate Cancer: The Light at the End of the Tunnel-or an Oncoming Train?Men with high-risk nonmetastatic CRPC should if possible be enrolled in a clinical trial and that patients with low-risk disease can be safely observed.
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Salvage External Beam Radiotherapy for Prostate Cancer After Radical ProstatectomyThis article defines the biochemical recurrence of prostate cancer, distinguish SRT from ART, outline the evidence for SRT, and makes recommendations with regard to radiotherapy volume and dose.
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Health Literacy, Communication, and Treatment Decision-Making in Older Cancer PatientsThe authors review the current trends in health literacy, patient-physician communication, and the medical treatment decision process, focusing attention on the older cancer patient population.
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Molecular Profiling Assays in Breast Cancer: Are We Ready for Prime Time?In this review, we will present the current data on commercially available molecular profiling assays in breast cancer and discuss the challenges surrounding their incorporation into routine clinical practice as prognostic and predictive tools.
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Hepatocellular Carcinoma: Neoadjuvant Therapy ReconsideredHepatocellular carcinoma (HCC) is an aggressive tumor that often occurs in the setting of chronic liver disease and cirrhosis. The incidence of hepatocellular carcinoma is increasing in the United States and worldwide. Orthotopic liver transplantation (OLT) is a viable and potentially curative option for selected patients with HCC. Locoregional therapy has been used to control HCC before transplantation because of the limited number of donor organs, to prevent tumor progression, and to decrease the incidence of dropouts from the transplant waiting list. Traditionally, multiple investigational locoregional modalities such as tumor resection, radiofrequency ablation, transarterial chemoembolization, and systemic chemotherapy have been used as "bridging" therapies. While the investigation of novel neoadjuvant treatments is justified in an effort to prevent tumor progression, the absence of randomized controlled trials leaves uncertainty about the utility of these maneuvers in improving outcome. This review summarizes the current data on the different modalities used worldwide in the neoadjuvant treatment of hepatocellular carcinoma, the rationale for these approaches, efficacy, potential complications, and future prospects.
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Commentary (Krishnan/Crane): Radiation Therapy in the Treatment of CholangiocarcinomaThe prognosis of patients with biliary cancers is poor. Although surgery is potentially curative in selected patients, local recurrence is a common pattern of failure. Adjuvant or neoadjuvant radiation therapy improves local control and possibly survival. In locally advanced patients, radiation therapy provides palliation and may prolong survival. Concurrently administered chemotherapy may further enhance these results. Newer radiation therapy techniques, including intraluminal transcatheter brachytherapy, intraoperative radiation therapy, intensity-modulated radiation therapy, and three- and four-dimensional treatment planning, permit radiation dose escalation without significant increases in normal tissue toxicity, thereby increasing the effective radiation dose. Preliminary results of studies employing hepatic transplantation with radiation therapy are encouraging. Although these new approaches hold promise, the prognosis in patients with biliary cancers remains poor, and the integration of novel therapeutic strategies is indicated.
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Patient Selection for Oral ChemotherapyOral chemotherapy has evolved with several new agents such as capecitabine, UFT, eniluracil, etc. in active clinical trials or already approved for use in the western world. Several distinct issues, apart from the usual criteria
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Colorectal Cancer: Chemotherapy Treatment OverviewFluorouracil (5-FU) has remained the standard therapy for the treatment of advanced colorectal cancer for over 40 years. Unfortunately, only a minority of patients experience objective clinical response.
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Chemobrain: Is It Time to Initiate Guidelines for Assessment and Management?Cognitive dysfunction during and following treatment for cancer, often referred to as “chemobrain,” is an adverse effect of cancer treatment that may interfere with patients’ ability to resume their precancer lifestyle, with subsequently reduced quality of life.
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Moving Forward in Hormone-Refractory Prostate Cancer: From Understanding Biology to Advancing TherapyHormone-refractory prostate cancer (HRCaP) is both heterogeneous and lethal. Multiple treatment options exist, including secondary hormonal manipulations, chemotherapy, experimental options, and best supportive care. Choosing the appropriate therapy for an individual patient depends on several important clinical factors such as the presence or absence of symptomatic metastatic disease, age and comorbidities, and prostate-specific antigen velocity. While only docetaxel (Taxotere)-based chemotherapy has been proven to improve survival in this setting, a wide range of therapies may be effective for any individual. Palliative maneuvers, such as external-beam radiation, bisphosphonate therapy, radiopharmaceuticals, and pain management are critical for appropriate patient management. Several promising novel therapies are in late-stage testing and will hopefully provide more treatment options for these patients.
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Cancer Metabolism as a Therapeutic TargetOngoing studies are attempting to understand the reasons that tumor cells engage in aerobic glycolysis in lieu of oxidative phosphorylation. In this review, we discuss known benefits to tumor cells from this metabolic switch, and we highlight key enzymes that play a role in aerobic glycolysis. We also describe novel therapeutic options targeting glucose metabolism.
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Suresh S. Ramalingam, MD, Discusses Adjuvant Therapy for Early NSCLC at 2021 ASCODuring the 2021 ASCO Annual Meeting, Suresh S. Ramalingam, MD, looked forward to how trials regarding adjuvant therapy for early-stage non–small cell lung cancer are poised to change the treatment paradigm in this setting.
